Provider Demographics
NPI:1093732745
Name:GHELLI, JODI (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:GHELLI
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:891 E WARNER RD
Mailing Address - Street 2:#100, PMB # 146
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-2965
Mailing Address - Country:US
Mailing Address - Phone:480-899-1629
Mailing Address - Fax:
Practice Address - Street 1:14 N COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-5737
Practice Address - Country:US
Practice Address - Phone:480-899-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-10997101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health